“It Changed Everything”: Skilled Nursing Provider Cantex Leverages I-SNP to Boost NOI and Transform Care

Skilled nursing providers are looking for ways to move forward as the long-term care industry moves increasingly toward a world of value-based payment.

Operators who have taken the plunge to create their own in-house insurance plans are beginning to see the move pay off, both clinically and financially to the business.

Institutional Special Needs Plans (I-SNPs), in particular, are seen as the future of skilled nursing facilities that have already been challenged by ongoing reimbursement changes – especially when the recovery after the pandemic remains slow.

Between 2020 and 2021, I-SNP enrollment decreased by 11%. From 2015 to 2021, however, enrollees have grown from 53,073 to more than 90,000, according to an analysis by healthcare consulting firm ATI Advisory.

In October, the Centers for Medicare & Medicaid Services (CMS) and Center for Medicare and Medicaid Innovation (CMMI) unveiled their updated 10-year strategic plan that highlighted its goal of moving all Medicare and the majority of beneficiaries Medicaid excluding fee-for-service (FFS) and in value-based payment and alternative methods.

American Health Care Association President Mark Parkinson went so far as to say in December that fee-for-service was “dying.”

For many years, Cantex Continuing Care Network, based in Carrollton, Texas, looked for ways to bring advanced practitioners into its buildings, preferably those employed by the operator, but there was no way of reimbursement. .

Cantex management decided to take matters into their own hands by launching an I-SNP and it has proven beneficial in more ways than one, according to Cantex Principal and Managing Partner Peter Longo.

“The institutionalized plans for special needs…was the source of funding to allow us to bring nurse practitioners, or physician assistants and primary care providers of other types, into our buildings and charge them, and it really changed everything in terms of how we provide care,” Longo said during a panel at the National Investment Center for Seniors Housing & Care’s spring conference in Dallas.

Cantex has qualified nursing, hospice and home care facilities in the states of Texas, Louisiana and New Mexico.

When Cantex was in the early stages of developing its I-SNP, those operating other established diets told Longo and his colleagues that financial advantage shouldn’t be the “main driver” for getting into the business. insurance.

Instead, Longo said, the goal is to “amplify” the clinical sense of a facility with a nurse practitioner who can closely supervise patients and residents to ensure quality outcomes.

“Ultimately, this will result in increased profitability,” he said.

The impact on costs and care

Having one nurse practitioner for every 60 members of the I-SNP plan has been a game changer in that the NP can really get to know and interact with the patients under their care, Longo said.

The role of the nurse practitioner in an I-SNP has also been shown to reduce rehospitalization rates, which can have both financial and outcome-of-care implications.

Longo said some data suggested I-SNP members saw rehospitalization rates about a third lower than the average nursing home resident.

“What we already know is that this is a demonstrable and material reduction in rehospitalization rates for members of institutionalized special needs plans, and that should come as no surprise when you have a care provider primary who just tends to a small group of patients and constantly interacts with them,” Longo said during the panel.

SNFs can be penalized by CMS if rehospitalization rates are too high.

The relationship between hospital systems and nursing homes has continued to evolve throughout the COVID-19 pandemic, but that dynamic has apparently been more collaborative lately. Yet hospitals are more aware than in the past of the quality of skilled nursing care and are determining referral relationships accordingly.

Kevin Mulhearn, chief financial officer of Hillcrest Health System, told Skilled Nursing News that he thinks hospitals are finally starting to understand where post-acute care fits into their business model.

“We experienced a new level of respect saying, ‘OK, I need you as a partner.’ As more and more people engage in any type of risky arrangement, which hospitals are increasingly aggressive against, they realize that not all providers are the same,” Mulhearn said.

Longo said that when Cantex’s I-SNP first started, he was initially concerned about how a director of nursing (DON) or other medical staff would react to a nurse practitioner entering the room. ‘establishment.

DONs have massively embraced the nurse practitioner, Longo said, because “he’s someone new who has advanced diagnostic and assessment skills and can do things that help them.”

This has proven itself in more ways than one for Cantex during the COVID-19 pandemic.

“The contribution of our nurse practitioners in terms of testing and vaccinations and other Covid-related procedures that we were undertaking, as well as infection control and just bringing calm to the building, in terms of having high-level practitioners level on site all the time, was great for us,” he said.

And Cantex wasn’t the only post-acute care provider to rely on its nurse practitioners during the pandemic.

Simpra Advantage, an I-SNP partnered with facilities in Alabama, had nurse practitioners caring for every patient at a facility, whether or not they were plan members, due to staffing challenges. that Covid was presenting, according to J. Mark Traylor, president at Traylor-Porter Healthcare and board member of Simpra Advantage.

“As an operator, that was a lifesaver,” Traylor told SNN in June 2021. “We had one of the worst houses in the state when it comes to outbreaks. It’s a very big house. They ended up with just under 50 patients at one point in the building with COVID, and then we had about 60 plus staff who contracted COVID.

Extend the reach of I-SNP

Now that Cantex’s I-SNP plan has become what Longo calls a “mature” Medicare Advantage plan, the operator is looking for ways to expand its reach by working with healthcare providers across the continuum of care. .

This means that nurse practitioners interface with new home care or palliative care patients in their own facilities, but also reach out to assisted living facilities in the communities where Cantex operates to gain new members. .

“Now…our businesses are wandering into each other, because now we’re looking over the bow of the ship and saying, ‘Well why are our members just our patients in our buildings, we’re surrounded …of assisted living facilities all around us who would also benefit from having plans like this in their buildings, but maybe they don’t have the financial means to do so,” Longo said during the panel. .

This can be done through an IE-SNP or equivalent institutional plan for special needs.

“There are future levels of this potential new tool to improve your NOI that could be even more beneficial to the bottom line in terms of bringing new revenue streams to your business that are profitable,” he said.

As the skilled nursing industry continues to change and evolve rapidly through both reimbursement and regulatory overhaul, Longo remains convinced that having an I-SNP and continuing to find ways to innovate allows Cantex to stay one step ahead.

“We are all trying to get traction in our markets, with our populations that we serve, by providing the most forward-thinking services, and I think you are always in a good position when trying to be ahead of the eight ball,” he said.

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